Safety and Efficacy of Transcatheter Arterial Chemoemboliazation in the Real-Life Management of Unresectable Hepatocellular Carcinoma

Background

Trans-arterial chemoembolization (TACE) is associated with better survival in BCLC-stage B patients with hepatocellular carcinoma (HCC) and Child-Pugh A whereas in Child-Pugh B there is no definite evidence of benefit.

Objectives

To assess the safety and efficacy of TACE during routine clinical practice in a consecutive Greek cohort of patients with unrespectable HCC.

Patients and Methods

Seventy one patients enrolled for this study (mean follow-up:24.6 months). 100 mg cisplatin, 50 mg doxorubicin and 10 ml lipiodol as well as embolic materials were used. CT-scans and blood tests were obtained prior and post-TACE. Kaplan–Meier method and Cox proportional hazard model were used to evaluate survival and factors affecting survival.

Results

Survival at 1-year, 2-years, 3-years and 5-years was 73.2%, 45.4%, 33.2% and 14.9% respectively. Procedure-related mortality was 1.4%. Multivariate analysis showed lesion diameter, Child-Pugh classification, alcohol abuse, tumor response and AFP prior TACE as independent prognostic factors of survival. Patients diagnosed during surveillance had significantly better survival rates compared to those diagnosed after development of symptoms (HR = 0.58, 95%CI: 0.33-1.01, P < 0.05).

Conclusions

TACE is safe and efficient for unrespectable HCC. Alcohol abuse, tumor burden, response criteria, Child-Pugh and AFP prior to the session were identified as independent predictors of survival whereas, adherence to surveillance programs resulted in significantly better survival in these patients.     

Dynamic CT perfusion imaging of intra-axial brain tumours: differentiation of high-grade gliomas from primary CNS lymphomas

Introduction:

Perfusion computed tomography (PCT) allows to quantitatively assess haemodynamic characteristics of brain tissue. We investigated if different brain tumor types can be distinguished from each other using Patlak analysis of PCT data.

Methods:

PCT data from 43 patients with brain tumours were analysed with a commercial implementation of the Patlak method. Four patients had low-grade glioma (WHO II), 31 patients had glioblastoma (WHO IV) and eight patients had intracerebral lymphoma. Tumour regions of interest (ROIs) were drawn in a morphological image and automatically transferred to maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and permeability (K ^Trans). Mean values were calculated, group differences were tested using Wilcoxon and Mann Whitney U-tests.

Results:

In comparison with normal parenchyma, low-grade gliomas showed no significant difference of perfusion parameters (p?>?0.05) , whereas high-grade gliomas demonstrated significantly higher values (p?<?0.0001 for K ^Trans, p?<?0.0001 for CBV and p?=?0.0002 for CBF). Lymphomas displayed significantly increased mean K^Trans values compared with unaffected cerebral parenchyma (p?=?0.0078) but no elevation of CBV. High-grade gliomas show significant higher CBV values than lymphomas (p?=?0.0078).

Discussion:

PCT allows to reliably classify gliomas and lymphomas based on quantitative measurements of CBV and K ^Trans.     

Choline-deprivation alters crucial brain enzyme activities in a rat model of diabetic encephalopathy

Diabetic encephalopathy describes the moderate cognitive deficits, neurophysiological and structural central nervous system changes associated with untreated diabetes. It involves neurotoxic effects such as the generation of oxidative stress, the enhanced formation of advanced glycation end-products, as well as the disturbance of calcium homeostasis. Due to the direct connection of choline (Ch) with acetylcholine availability and signal transduction, a background of Ch-deficiency might be unfavorable for the pathology and subsequently for the treatment of several metabolic brain diseases, including that of diabetic encephalopathy. The aim of this study was to shed more light on the effects of adult-onset streptozotocin (STZ)-induced diabetes and/or Ch-deprivation on the activities of acetylcholinesterase (AChE) and two important adenosinetriphosphatases, namely Na⁺,K⁺-ATPase and Mg²⁺-ATPase. Male adult Wistar rats were divided into four main groups, as follows: control (C), diabetic (D), Ch-deprived (CD), and Ch-deprived diabetic (D+CD). Deprivation of Ch was provoked through the administration of Ch-deficient diet. Both the induction of diabetes and the beginning of dietary-mediated provoking of Ch-deprivation occurred at the same day, and rats were killed by decapitation after 30 days (1 month; groups C1, D1, CD1 and D1+CD1) and 60 days (2 months; groups C2, D2, CD2 and D2+CD2, respectively). The adult rat brain AChE activity was found to be significantly increased by both diabetes (+10%, p < 0.001 and +11%, p < 0.01) and Ch-deprivation (+19%, p < 0.001 and +14%, p < 0.001) when compared to the control group by the end of the first (C1) and the second month (C2), respectively. However, the Ch-deprived diabetic rats’ brain AChE activity was significantly altered only after a 60-day period of exposure, resulting in a +27% increase (D2+CD2 vs. C2, p < 0.001). Although the only significant change recorded in the brain Na⁺,K⁺-ATPase activity after the end of the first month is attributed to Ch-deprivation (+21%, p < 0.05, CD1 vs. C1), all groups of the second month exhibited a statistically significant decrease in brain Na⁺,K⁺-ATPase activity (−24%, p < 0.01, D2 vs. C2; −21%, p < 0.01, CD2 vs. C2; −22%, p < 0.01, D2+CD2 vs. C2). As concerns Mg²⁺-ATPase, the enzyme’s activity demonstrates no significant changes, with the sole exception of the D2+CD2 group (+21%, p < 0.05, D2+CD2 vs. C2). In addition, statistically significant time-dependent changes concerning the brain Mg²⁺-ATPase activity were recorded within the diabetic (p < 0.05, D2 vs. D1) and the Ch-deprived (p < 0.05, CD2 vs. CD1) rat groups. Our data indicate that Ch-deprivation seems to be an undesirable background for the above-mentioned enzymatic activities under untreated diabetes, in a time-evolving way. Further studies on the issue should focus on a region-specific reevaluation of these crucial enzymes’ activities as well as on the possible oxidative mechanisms involved.     

Muscular mass assessed by ultrasonography after administration of low-dose corticosteroids and muscle relaxants in critically ill hemiplegic patients

BACKGROUND AIMS: The present study investigates the influence of low-dose and short- term administration of corticosteroids and muscle relaxants on the muscular mass (MM) in hemiplegic ICU patients, with the aid of ultrasonography (U/S). METHODS: Thirty-seven patients hospitalised in the ICU for 18.6+/-3.6 days, were included in the study. Sixteen patients did not receive either drug (group A), five patients received dexamethasone (24 mg/day) for 4 days (group B), eight patients received dexamethasone (24 mg/day) for 4 days and atracurium (0.3-0.6 mg/kg/h) for 2.8+/-0.4 days (group C), whereas eight other non-hemiplegic ICU patients comprised the control group. MM was measured in cm by U/S and serum Albumin (ALB, g/l) at the first and the tenth ICU hospitalisation day. The corresponding differences (DeltaMM, DeltaALB) were compared between the four groups of patients. RESULTS: MM and ALB decreased significantly in all groups. DeltaMM was significantly higher in group C in comparison to all other groups, while DeltaMM was also higher in group B, when compared to the control and A groups. DeltaALB did not show significant inter-group differences. DeltaMM was significantly related to patients' age (r=0.41,P =0.001). CONCLUSIONS: Muscular atrophy of the ICU hemiplegic patients is significantly influenced by the synchronous treatment with muscle relaxants and corticosteroids at low doses and for short term. This myopathy should be taken into account for the better prognosis and the safer outcome of the patient and U/S is suitable for accurate and non-invasive monitoring of MM.     

Infantile myofibromatosis with visceral involvement and complete spontaneous regression

Infantile myofibromatosis is an unusual mesenchymal disorder characterized by the proliferation of tumors in the skin, muscle, bone, and viscera. Two types can be distinguished; the solitary type, defined by the presence of one nodule in the skin, muscle, bone or subcutaneous tissue; and the multicentric type which can be divided into two sub-types. In the first sub-type the lesions are multicentric but without visceral involvement, while in the second, visceral involvement is present. The prognosis of the disease depends on whether visceral involvement is present. Solitary and multicentric nodules without visceral involvement usually have excellent prognosis with spontaneous regression of lesions within 1 to 2 years of diagnosis. On the other hand, visceral lesions are associated with a significant morbidity and mortality, resulting from vital organ obstruction, failure to thrive, or infection. Death in these cases often occurs at birth, or soon after, and is usually due to cardio-pulmonary or gastrointestinal complications. The case being reported here, is that of a female newborn who had multiple skin, subcutaneous tissue, skeletal muscle, bone, and lung lesions immediately after bith. At the age of three years, the child is in good health, her psychomotor development is in accordance with her age group, and the lesions have completely regressed. This is a case of the multicentic type of infantile myofibromatosis with visceral involvement, where all lesions have spontaneously regressed. This is a rarity since the prognosis in the majority of such cases is poor.     

Pulmonary sarcoidosis. Correlation of expiratory high-resolution CT findings with inspiratory patterns and pulmonary function tests

Purpose: To assess the presence and extent of air trapping (AT) on chest high-resolution CT (HRCT) in sarcoidosis and to correlate such findings with patterns, lesion extent on inspiratory CT and pulmonary function tests (PFT).Material and Methods: Thirty patients with sarcoidosis underwent inspiratory and expiratory HRCT and PFT. HRCT images were evaluated for presence, distribution and AT extent as well as the predominant HRCT pattern and the extent of lesions at inspiration. Attenuation difference in the AT regions at expiration and at inspiration were calculated. The presence and extent of AT were correlated with PFT, extent of involvement and predominant inspiratory patterns.Results: AT was present in 25/30 patients with no lung zone predilection. AT was the only CT indication of pulmonary sarcoidosis in 3/30 patients who also had normal PFT. Attenuation difference between inspiration and expiration ranged from -40 HU to 106 HU. In 2 patients, a paradoxical decrease of lung attenuation was observed at expiration. A significant correlation was found between AT extent at expiration, with residual volume-total lung capacity ratio and residual volume.Conclusion: AT is an additional HRCT finding in sarcoidosis. AT may involve any lung zone, including costophrenic angles and may be the only CT feature of pulmonary sarcoidosis. Strong correlation is only found with PFT values that are specific for incomplete lung emptying at expiration.     

Estimation of fetal radiation dose from computed tomography scanning in late pregnancy: depth-dose data from routine examinations

RATIONALE AND OBJECTIVES: To provide depth-dose data for estimating fetal radiation dose from routine computed tomography (CT) examinations of the trunk. METHODS: Doses were measured during CT examinations of the thorax, upper abdomen, abdomen, and pelvis in two anthropomorphic phantoms simulating pregnant women in the second and third trimesters. Thermoluminescent dose meters were used for dose measurements. RESULTS: In CT examinations of the abdomen, doses of 30.0 to 43.6 mGy and of 29.1 to 42.0 mGy were measured at the measuring points in the phantom simulating pregnancy in the second and third trimesters, respectively. In CT examinations of the upper abdomen, pelvis, and thorax, both phantoms received lower doses of radiation. Knowledge of the normalized weighted dose index of the CT scanner and of the kVp and mAs settings of the protocol used for examination of the pregnant woman is needed to adjust the dose data found in the present study to modified protocols and different CT equipment. CONCLUSIONS: These dosimetric data may be used to guide the management of pregnant patients undergoing CT examinations of the trunk.     

Adult pertussis is hazardous for the newborn.

We report 4 cases involving the likely transmission of pertussis from parents to newborns in a hospital setting. The adoption of proper infection control measures and targeted screening of parents may reduce the potential for such transmission.